Narrowing of the lumen of the right vertebral artery. Syndrome of the vertebral artery with cervical osteochondrosis - symptoms. How to treat vertebral artery syndrome at home

Vertebral artery syndrome is a complex of symptoms that occurs when there is a violation of the blood supply to the brain as a result of damage to one or two vertebral arteries.

The symptom complex is not a separate disease, but a set of a number of symptoms that are present in a patient in a certain period of time and have a common mechanism of development. Each syndrome may be characteristic of one or more diseases.

General information

The treatment of vertebral artery syndrome is carried out by vertebrologists - doctors whose field of activity is the treatment of diseases of the spine and the musculoskeletal system.

The fact that turning the head to the side causes compression of the contralateral vertebral artery at the level of the body of the atlas was written in 1903 by Gerenbauer. In the 60s of the XX century. B.Chrast, J.Korbicka established a decrease in blood flow in the vertebral artery during flexion and extension of the head, as well as a decrease in blood flow in the homolateral artery when the head is tilted to the side and a decrease in blood flow in the contralateral artery when the head is turned.

Syndrome of vertebral arteries, according to Y.Yu.

The osteochondrosis of the spine itself, according to vertebrologists from different countries, is detected in 70% of the adult population.

Forms

Depending on the cause of occurrence, vertebral artery syndrome is divided into:

• compression form, which occurs with mechanical pressure on the wall of the artery;
• irritative form, the cause of which is a reflex spasm of the artery that occurs in response to irritation of sympathetic fibers;
• angiospastic form, in which reflex spasm is caused by irritation of receptors located in the region of the motor segments of the cervical spine (less associated with head turns);
• mixed form.

In practice, combined options are most often detected:

• Compression-irritative form, in which compression of the artery causes mechanical compression of the vertebral artery and its nerve plexus. Narrowing of the artery occurs due to spasm of the vessel and extravascular (extravasal) compression.
• A reflex-angiospastic form, in which the development of arterial spasm is associated with a reflex response that occurs when the afferent structures of the spinal nerve are irritated. Pathological processes in the intervertebral discs and intervertebral joints lead to irritation of the receptors, and the resulting flow of pathological impulses is directed to the sympathetic plexus of the vertebral artery and vertebral nerve, provoking vasospasm. In this form, the spasm of the vertebrobasilar basin of the vertebral arteries is more pronounced than in the presence of compression.

Depending on the clinical picture and the degree of circulatory disorders (hemodynamics), the vertebral artery syndrome is divided into:

• The functional stage, in which patients suffer from a headache accompanied by autonomic disorders (acute throbbing, constantly aching or sharply aggravated with prolonged static load or a sharp turn of the head). Pain often spreads from the back of the head to the forehead. There are also cochleovestibular disorders (there is systemic or paroxysmal dizziness), visual impairment (darkening in the eyes, sparks, a feeling of sand in the eyes), perhaps a slight hearing loss.
• Ischemic or organic stage, in which transient and persistent hemodynamic disorders of the brain are detected. It develops as a result of long and prolonged episodes of vascular disorders, as a result of which persistent foci of ischemia are formed. Hemodynamic transient disturbances are accompanied by dizziness, nausea, vomiting and speech disorder. During the tilt or turn of the head, ischemic attacks (drop attacks) occur, which are accompanied by a fall with the preservation of consciousness. Syncopal episodes are also observed, in which there is a loss of consciousness lasting up to 10 minutes. In a horizontal position, the symptoms usually regress. After ischemic attacks, the patient may experience weakness, autonomic disorders and tinnitus.

Focusing on clinical types, there are:

• Posterior cervical spastic syndrome (Bare-Lieu syndrome), in which the headache is localized in the cervical-occipital region and radiates to the front of the head. Pain occurs in the morning (especially if the patient slept on an uncomfortable pillow), while walking, while driving a car and when turning the neck. It can be pulsating in nature, localized in the cervical-occipital region and radiate to the parietal, temporal and frontal parts of the head. When turning the head, pain may increase, vestibular, visual and vegetative disorders are possible.
• Basilar migraine, in which vertebral artery syndrome occurs as a result of stenosis of this artery. The headache is paroxysmal. The attack is characterized by a sharp headache in the occipital region, which is accompanied by vomiting. Loss of consciousness, dizziness, ataxia, visual disturbances and speech disorder are also possible.
• Vestibulo-cochlear syndrome, in which persistent and reduced perception of whispered speech associated with head movements, systemic and non-systemic dizziness are observed.
• Ophthalmic syndrome, which is characterized primarily by visual disturbances (decreased vision, lacrimation as a result of conjunctival hyperemia). When the position of the head changes, visual fields may be lost.
• Syndrome of vegetative changes, which is accompanied by a feeling of heat, a feeling of cold extremities, sweating, changes in skin dermographism, sleep disturbances.
• Transient ischemic attacks (observed at the ischemic stage of the vertebral artery syndrome), which are accompanied by transient motor and sensory disturbances, visual disturbances (including bilateral blindness in half of the visual field), impaired coordination of movement, bouts of dizziness, nausea, vomiting, impaired speech and swallowing .
• Unterharnsheit's syndrome, in which there is a syncopal state as a result of an acute circulatory disorder in the region of the reticular formation. A short-term loss of consciousness occurs with a sharp turn of the head.
• An episode of a drop attack that occurs when there is a violation of blood circulation in the caudal regions of the brain stem and cerebellum. The resulting paralysis of all limbs (tetraplegia) is associated with the tilting of the head. Motor functions are restored fairly quickly.

Reasons for development

The vertebral artery syndrome can develop with various diseases that can be divided into two groups. The first group includes diseases associated with the spine (vertebrogenic syndrome of the vertebral artery):

• osteochondrosis (dystrophic disorders in articular cartilage);
• spondylosis (proliferation of vertebral tissue in the form of spikes);
• protrusion (bulging of the intervertebral disc into the spinal canal with the preservation of the fibrous ring);
• intervertebral disc herniation, in which the nucleus pulposus of the intervertebral disc is displaced and is accompanied by a rupture of the fibrous ring;
• displacement of the vertebrae, in which the vertebral bodies are displaced relative to each other and relative to the vertical axis;
• traumatic injuries;
• scoliosis of the cervical region.

The syndrome of the vertebral artery of the vertebrogenic type can also occur with congenital anomalies in the development of the vertebrae (Kimmerli anomaly, which is characterized by the presence of an additional bone arch in the cervical spine, etc.).

The non-vertebrogenic type of the syndrome can occur when:

• atherosclerosis, which is associated with the deposition of cholesterol and other fats in the form of plaques and deposits;
• anomalies in the development of blood vessels;
• vasospasm.

The most frequently observed syndrome of the vertebral artery in cervical osteochondrosis.
Predisposing factors for the appearance of symptoms in the presence of these conditions are sharp turns and tilts of the head, which provoke significant unilateral compression of the vessel.

Pathogenesis

The pathogenesis of vertebral artery syndrome is associated with the anatomical structure of the spine and its surrounding ligaments, muscles, nerves and blood vessels.

Blood enters the brain through two internal carotid arteries and two vertebral arteries, and the outflow of blood is carried out through two jugular veins.

Through the vertebral arteries, which form the vertebrobasilar basin and supply the posterior parts of the brain, 15-30% of the required blood volume enters the brain.

The vertebral arteries originating in the chest cavity enter the transverse foramen of the sixth cervical vertebra and pass through the overlying cervical vertebrae along the bone canal (the bone canal is formed by the transverse processes of the cervical vertebrae). The vertebral arteries enter the cranial cavity through the foramen magnum, merging in the region of the basilar sulcus of the pons into the main (basilar) artery.

Since the vertebral arteries supply blood to the cervical spinal cord, medulla oblongata and cerebellum, insufficient blood supply causes symptoms characteristic of the defeat of these departments (tinnitus, dizziness, impaired body statics, etc.).

Since the vertebral arteries are in contact not only with the structure of the spine, but also with the soft tissues surrounding the spinal column, the vertebral artery syndrome is distinguished by various development mechanisms.

The vertebral artery is divided into intracranial and extracranial sections, a significant part of which passes through the movable canal formed by the openings of the vertebrae. In the same canal is Frank's nerve (sympathetic nerve), the posterior trunk of which is localized on the posterior medial surface of the vertebral artery. Due to this arrangement, when the receptors of the spinal motion segment are stimulated, a reflex response of the vertebral artery wall occurs. In addition, at the level of the atlas and axis (C1 and C2 vertebrae), the vertebral arteries are covered only by soft tissues, which, combined with the mobility of the cervical region, increases the risk of developing a compression effect on the arteries from the surrounding tissues.

Degenerative changes in the cervical region resulting from osteochondrosis, deforming spondylosis, proliferation of osteophytes and other pathologies often cause compression of the vertebral arteries.

In most cases, compression is detected at the level of 5-6 vertebrae, but can also be observed at the level of 4-5 and 6-7 vertebrae. In addition, the syndrome of the vertebral artery often develops on the left side, since the development of atherosclerosis is more often observed in the vessel departing from the aortic arch. An additional cervical rib is also more often detected on the left side.

Symptoms

The main symptoms of vertebral artery syndrome include:

• Headache, which in most cases is localized in the back of the head, but can be localized in the parietal and frontal regions. Pain may be accompanied by nausea and vomiting, and a certain position of the head helps to reduce pain.
• Dizziness, loss of balance, tinnitus (vestibular disorders).
• Visual disturbances (decreased visual acuity, photopsia).
• Pain in the neck.
• Arterial hypertension, which occurs as a result of insufficient oxygen supply to the medulla oblongata. Oxygen starvation stimulates the heart and leads to an increase in pressure. At the initial stage, the increase in pressure is of a compensatory nature, but then the situation worsens, since with an increase in blood pressure, the blood flow is not able to overcome the mechanical barrier.
• Transient ischemic attacks, which are accompanied by impaired speech and sensory and motor disorders.

With a reflex-angiospastic form, the vertebral artery syndrome can manifest itself:

• headache of a vascular nature, the appearance of which is affected by stress, endocrine cycles, overheating, weather conditions and fluctuations in total blood pressure;
• syncopal attacks of Unterharnscheidt, in which fainting occurs after movement of the head, a feeling of heat and a feeling of "bursting" in the head, photopsia and dizziness;
• cochleovestibular disorders (dizziness) that appear with changes in the position of the head;
• visual disturbances (flickering scotoma, fog before the eyes, pain in the eye, photophobia, lacrimation), laryngo-pharyngeal symptoms (tingling in the throat, taste perversion, sensation of perspiration, cough, dysphagia);
• changes in the mental sphere (senestopathic experiences, asthenic, anxiety-hypochondriac and sometimes hysterical states).

Syndrome of the vertebral artery against the background of cervical osteochondrosis (compression-irritative form of the syndrome) manifests itself:

• Headaches and paresthesias of the hemicranic type. Headache is characterized by irradiation of the type of "removing the helmet" and paroxysmal intensification with certain movements in the cervical spine, with tonic tension of the neck muscles and a long monotonous position of the head.
• Painful contracture of the muscles of the neck and a crunching sensation in the neck that occurs during movement (symptoms of cervical osteochondrosis). There may be compression radicular syndromes and cervical myelopathy.
• Cochleovestibular disorders that develop as a result of lesions of peripheral, stem and supranuclear vestibular formations.
• Visual and oculomotor disorders (narrowing of visual fields).
• Various variants of the Wallenberg-Zakharchenko syndrome.
• Bouts of "drop attacks".
• hypothalamic disorders.

Diagnostics

Diagnosis of the syndrome is quite difficult, since diagnostic errors are possible with insufficient examination of patients with vestibulo-atactic or cochlear syndrome.

The diagnosis of "vertebral artery syndrome" is based on the following criteria:

• neurological manifestations refer to the vertebrobasilar vascular system;
• clinical symptoms refer to one of 9 clinical variants or their combinations and depend on the position of the cervical spine and its movements;
• MRI or MSCT in the cervical spine visualizes morphological changes that can cause the syndrome.
• with the help of ultrasound, the presence of a change in blood flow is detected, which occurs as a result of performing functional tests (flexion-extension of the head and head turns).

Diagnostics includes:

• cervical radiography;
• MRI of the brain;
• ultrasound dopplerography.

Treatment

Vertebral artery syndrome is treated with:

• Drug therapy aimed at reducing the perivascular (localized around the vessels) edema that has arisen during mechanical compression. Venous outflow is regulated by taking troxerutin, ginkgo biloba, diosmin. Non-steroidal anti-inflammatory drugs (celecoxib, etc.) are also prescribed. To improve the blood supply to the brain, vinpocetine or vincamine (vinca derivatives), trental (purine derivatives), calcium antagonists or alpha-blockers are prescribed.
• Neuroprotective therapy that helps improve energy processes in the brain and minimize the risk of neuronal damage as a result of episodic circulatory disorders. For this, cerebrolysin or other drugs that improve regeneration, cholinergic drugs (gliatilin), metabolic drugs (trimetazidine, etc.) are prescribed.
• Symptomatic therapy, which may include the use of muscle relaxants, anti-migraine drugs, etc.
• Surgical methods that are used in case of severe compression of the arteries (with a herniated disc or the presence of an osteophyte) and no effect when using other methods of treatment.
• Non-drug methods (physiotherapy, massage, acupuncture, hirudotherapy, manual therapy and exercise therapy).

Massage for vertebral artery syndrome is performed in the neck and collar area (performed every six months - a year, starting from the subacute period of the disease).

Exercises for vertebral artery syndrome are selected by the doctor on an individual basis, since both excessive and insufficient physical activity can harm the patient. In addition, it is important to remember that active movements are contraindicated in the acute period of the disease.

Gymnastics for vertebral artery syndrome may include:

• turns and tilts of the head to the sides;
• nodding;
• moving the head forward and backward;
• shrugging shoulders and other exercises affecting the shoulder joint;
• hand pressure on the head opposite to the turn;
• circular movements of the head.

All movements are performed 5-10 times.

There are also exercises aimed at relaxing, stretching and strengthening the muscles of the neck (for self-resistance), but they are shown only during the recovery period.

Treatment of vertebral artery syndrome with folk remedies should be combined with drug treatment. From folk methods you can apply:

• Coniferous baths, for which pine, fir, spruce or cedar needles are used. Take a coniferous bath that relieves muscle spasm and improves blood flow for 20-30 minutes.
• Reception of infusion of oregano, which is brewed at the rate of 2 tbsp. spoons of grass per 1 liter of boiling water and insist 12 hours (overnight). During the day, the infusion is drunk in 4 divided doses.

Prevention

Prevention of vertebral artery syndrome includes:

• daily exercise;
• sleep on an orthopedic pillow and mattress;
• timely massage courses;
• timely treatment of osteochondrosis.

Diseases of the cervical spine have now become widespread not only among the elderly and middle-aged, but also among young people. At the same time, the number of vertebrogenic vascular disorders of the brain is growing, which have become an urgent problem of modern medicine. And an important role in such a situation is played by stenosis of the vertebral artery.

General information

The blood supply to the brain is carried out from two main pools: carotid and vertebral (respectively, the carotid and vertebral arteries). The latter covers a quarter of the entire need for oxygen and nutrients - it vascularizes the following structures:

• brain stem.
• Cerebellum.
• Occipital lobes.
• An extensive part of the temporal lobes.
• Posterior hypothalamus.
• Spinal cord (segments C1–Th3).
• Inner ear.

The defeat of the vertebral artery in diseases of the cervical region is determined by its anatomical and topographic features. The vessel, together with the nerve of the same name, passes in the canal, which is formed by holes in the transverse processes of the vertebrae. The latter is not static, as it changes according to movements in the neck. In the vertebral artery itself, according to its location, several segments are distinguished:

• 1 - from the subclavian artery to the entrance to the canal.
• 2 – in the canal at the level of C2–C6 vertebrae.
• 3 - from the exit from the canal to the entrance to the cranial cavity.
• 4 - in the cranial cavity (intracranial).

In the canal, the artery borders behind on the uncovertebral articulations, and on the side, on the superior articular processes. After leaving it, the vessel bends twice: in the frontal and sagittal planes. It is in these places that a violation of blood flow through the vertebral artery often occurs.

The topographic and anatomical features of the vertebral artery make it vulnerable to the adverse effects of a number of external and internal factors that contribute to impaired blood flow through the vessel.

The reasons

The narrowing of the lumen of any vessel is provoked by several reasons. It is possible to compress the wall from the outside with pathological formations (bone fragments, tumor, hematoma, etc.), internal blockage by an atherosclerotic plaque, thrombus, embolism, and, finally, spasm of the own muscle membrane (most often reflex). In relation to the vertebral artery, it is customary to distinguish two main groups of factors:

• Vertebrogenic.
• Non-vertebrogenic.

The former cause external compression of the vascular wall and the adjacent nerve due to pathological changes in the cervical region. In this case, the pressing elements are:

• Bone growths (osteophytes).
• Herniated discs.
• Osteoarthritis (articular joints,).
• Instability of the vertebral segments.

Structural disorders in the spine affect not only the artery itself, but also the nerve fibers surrounding it, leading to reflex spasm. The factors of external compression can be safely attributed to the muscles of the neck - hypertrophied or spasmodic (anterior scalene, inferior oblique) - which often accompanies the pathology of the spinal column.

It should be noted that even under physiological conditions, the vertebral artery is subject to a change in its lumen during head movements, but normally, blood flow restriction is well compensated. And if, along with external compression, there are changes in the vessel itself, then the situation is aggravated many times, manifesting itself as clear hemodynamic disturbances in the vertebrobasilar basin. Factors unrelated to the condition of the spine include:

• Internal occlusion for thrombosis, atherosclerosis, arteritis, embolism.
• Vascular deformities: pathological tortuosity, additional loops, kinks, path anomalies.
• External compression by scars, adhesions, hematomas and other volumetric formations.

Thus, the causes of stenosis cover a wide range of pathologies, both local and systemic. Therefore, in the practice of a neurologist, vertebrologist and traumatologist, great importance is given to the differential diagnosis of the vertebral artery syndrome.

The narrowing of the vertebral artery in most cases is due to the pathology of the cervical region, but there are also non-vertebrogenic causes of stenosis.

Symptoms

Based on the functional load on the vertebral artery, it is easy to predict what manifestations of stenosis may be. Violation of blood flow through the vessel with the failure of compensatory mechanisms provokes hypoxic changes on the part of those structures that are fed from the vertebral part of the brain basin. Of course, everything depends on the severity of pathological changes, but it should be mentioned that hemodynamically significant stenosis corresponds to the overlap of the vascular lumen by 50% or more. Accordingly, the stronger the external compression or internal occlusion, the more significant the clinical picture.

The complex of neurological disorders that occur during stenosis is combined into a concept. In the early stages, it has a functional nature, i.e., it occurs only at the moment of provoking movements - a sharp tilt or turn of the head - as well as in the case of a prolonged forced position. This causes the following symptoms:

• Headache.
• cochleovestibular disorders.
• visual disturbances.
• Vegetative dysfunction.

Vertebrogenic pains have a burning, throbbing or aching character, they are paroxysmal intensified, spreading from the back of the head to the parietal-temporal and frontal zone. Cochleovestibular disorders include dizziness, unsteadiness, and unsteady gait. Visual impairment is manifested by darkening, flickering of “flies” or “zigzags” before the eyes (photopsies). This may be accompanied by autonomic reactions such as a feeling of heat, increased sweating, increased heart rate.

With persistent and severe stenosis, acute and transient disorders of cerebral circulation are observed, leading to the appearance of foci of ischemia. Transient attacks do not last more than 48 hours and are characterized by:

• Vertigo.
• Ataxia (coordination disorders).
• Nausea, vomiting.
• Speech disorders.

In addition, sensitive disturbances are possible in the form of numbness and crawling "goosebumps" around the mouth, in the region of the upper or lower extremities. As a rule, this symptom is unilateral in nature, appearing with the syndrome of the left or right vertebral artery.

If the stenosis is of vertebrogenic origin, then transient ischemic disorders can be detected during movements in the neck. So, patients often experience sudden falls with the preservation of consciousness (drop attacks) or fainting (syncope). After such an attack, general weakness, lethargy, headache, tinnitus, flickering of "flies" in the eyes, sweating are noted.

In vertebral artery syndrome, a combination of various clinical variants of hypoxic-ischemic disorders in the brain structures is observed.

Additional diagnostics

Vertebral artery syndrome requires careful differentiation from other conditions that have similar features. The polymorphism of the clinical picture makes it difficult to form a preliminary conclusion - there is a risk of both underdiagnosis and overdiagnosis. But along with this, the doctor necessarily focuses on the results of additional studies that allow to identify changes in the spine, the vessel itself or the surrounding soft tissues. These include:

• with functional load.
• Tomography (magnetic resonance, computer).
• Doppler ultrasound.

Only in the presence of all clinical and instrumental signs, one can safely assert about stenosis of the vertebral artery and count on its adequate treatment.

Treatment

To effectively treat vertebral artery syndrome, you need to know its cause. Based on the variety of pathological processes and mechanisms that contribute to stenosis, therapy is characterized by the breadth of impact using various methods and techniques. But each case is, of course, individual, and the approach to the patient should be carried out through the prism of all the characteristics of the body, and not just taking into account the degree of narrowing.

Medical

Drugs are of great importance in the treatment of vertebral artery syndrome. The list of drugs used in such patients is quite impressive, since it is required to act not only on clinical symptoms or altered structures of the spine, but also on the vessel wall, blood flow in it, and brain tissues susceptible to hypoxia. Therefore, such drugs are used:

• Non-steroidal anti-inflammatory (Xefocam, Larfix,).
• Muscle relaxants (Mydocalm).
• Decongestants (L-lysine aescinate).
• Vascular (Latren, Actovegin).
• Antispasmodics (No-shpa).
• Metabolic (Mexidol, Cytoflavin).
• Neuroprotectors (Cortexin).
• Venotonics (Detralex, Troxevasin).
• Chondroprotectors (Don, Artra).
• Vitamins (Milgamma,).

Severe pain syndrome can be stopped with the help of paravertebral blockades with Novocaine and glucocorticoids (Diprospan). Local forms of drugs (ointment, gel, cream) are also of some importance.

Drug treatment of vertebral artery syndrome is carried out in strict accordance with the recommendations of a specialist. You can not deviate from medical appointments, because the final effect depends on it.

Non-drug

Among the conservative measures used in patients with stenosis of the vertebral artery, non-drug agents are widely used. They act on the factors of external vessel compression, surrounding tissues, improve cerebral blood flow and have a general tonic effect. The following treatment methods are used:

• Physiotherapy.
• Gymnastics.
• Massage.
• Manual therapy.

It must be remembered that an active impact on the spine should be carried out only after the elimination of acute events, because otherwise the symptoms of the pathology will only worsen. This applies to physiotherapy exercises with post-isometric exercises, and manual therapy. You should wait until the full effect of the use of medicines is manifested.

Surgical

In order to completely eliminate the basis of the vertebrogenic syndrome, in many cases one has to turn to surgeons for help. Operatively, volumetric formations protruding into the spinal canal (osteophytes, hernias) are eliminated, thus decompressing the artery. Sometimes it is necessary to perform a resection of the sympathetic nerve plexus, and in case of internal blockage, vascular techniques are used to remove blood clots and plaques.

The effectiveness of treatment largely depends on the timely conduct of diagnostic measures. Regardless of the causes of stenosis - associated with the spine or non-vertebrogenic - the appearance of clinical symptoms should be a reason to consult a doctor. And the specialist will determine their origin and prescribe the appropriate therapy.

The vertebral artery is a paired vessel that departs from the subclavian artery and, together with the carotid arteries, provides blood supply to the brain.

With vascular anomalies, prerequisites are created for a decrease in cerebral blood flow. This is exactly what happens with hypoplasia of the right vertebral artery, and what is it? Hypoplasia is the underdevelopment of an organ, the result of which is a decrease in its functionality. In the case of the vertebral artery, we are talking about hypoplasia when the vessel diameter is reduced to less than 2 mm. This type of anomaly is congenital in nature and is often a consequence of the pathology of pregnancy.

Symptoms often occur only in adulthood due to a deterioration in the elasticity of blood vessels and the addition of atherosclerosis. In such a situation, there may be a decrease in blood flow to certain parts of the brain. Up to a certain limit, the pathology of the blood supply can be compensated, but the body's defense mechanisms may be depleted or not work in emergency situations.

Differences from lesions of the left vertebral artery are usually absent. The only difference is that the right-sided vascular lesion occurs several times more often than the left-sided one - according to some observations, in a ratio of about 3 to 1.

A snapshot of computed tomography

It is difficult to give an unambiguous answer about the danger of the condition. Brain neurons are especially sensitive to malnutrition due to impaired blood supply. Therefore, hypoplasia of the arteries leading to the brain can lead to more serious consequences for the body compared to the underdevelopment of other vessels. The degree of danger depends on the severity of hypoplasia and related health problems (vascular diseases, pathology of the cervical spine, heart disease).

A complete cure of the disease is impossible, even after surgery, only temporary compensation of local blood flow can be achieved.

Neuropathologists are usually involved in the treatment of hypoplasia of the vertebral arteries. Only those patients in whom hypoplasia is manifested by certain symptoms of deterioration of cerebral circulation need medical attention. With a significant narrowing of the lumen of the vessel with severe symptoms of circulatory disorders, it is necessary to consult a vascular surgeon to decide on the need for surgery.

Causes of hypoplasia of the right vertebral artery

Underdevelopment of the vertebral vessels is often detected incidentally in adulthood during the examination. However, this pathology is congenital. Various health problems of a pregnant woman, injuries during gestation, and hereditary predisposition can lead to underdevelopment of blood vessels.

List of possible causes of vertebral artery hypoplasia:

1. Infections transferred during pregnancy: rubella, influenza, toxoplasmosis.
2. Bruising or trauma to the mother.
3. The use of alcohol, drugs during pregnancy, smoking, drug addiction.
4. Genetic features that increase the risk of the formation of defects in the circulatory system.

Pathology can be asymptomatic for a long time. With a slight severity of circulatory disorders and symptoms, the condition can be mistakenly attributed to other pathologies: osteochondrosis, vegetative-vascular dystonia.

Hypoplasia is considered one of the most common anomalies of the vertebral arteries. Data on the prevalence of hypoplasia among the population differ in different sources and range from 2.5 to 26.5% of cases. But it is known that hypoplasia of the vertebral artery on the right is much more common than on the left or on both sides at the same time. This is probably due to the anatomical features of the formation of vascular formations. The vessel on the right departs from the subclavian artery at an acute angle, on the left almost at a right angle, the diameter of the right artery is often less than the left, and its length is greater.

The asymptomatic course of the anomaly of the right vertebral artery indicates sufficient compensation of blood flow due to the existing connections (anastomoses) between the vessels and due to the developed network of collaterals - branches of other vessels that supply blood to the same areas as the vertebral artery. Ensuring a uniform blood flow to all parts of the brain is largely due to the presence of closed circulatory systems, when the arteries of different vascular pools merge with each other. These protective mechanisms often compensate for insufficient blood flow through the right vertebral artery for a long time. Therefore, clinical manifestations often occur gradually as age-related changes develop.

Symptoms of pathology

The symptoms of this disease are very diverse and can vary significantly in different patients.

Here are some groups of symptoms:

Characteristics of the manifestations of the disease:

• Pain in pathology can vary significantly in intensity and other characteristics.
• Often, patients feel a throbbing or shooting pain that spreads from the neck and back of the head to the temporo-frontal regions.
• The pains are aggravated by turning the head, at night and after waking up.
• Often, hypoplasia is manifested by dizziness, a feeling of disorientation, and a distortion in the perception of the position of the body in space. Such episodes are often associated with head tilts, sudden movements. They can lead to staggering or even falling.
• Sharp attacks of dizziness are sometimes accompanied by loss of consciousness, fainting.

In addition to the pain syndrome in pathology, the following disorders may occur:

• blurred vision, eye pain, double vision, a feeling of sand or flies;
• hearing loss, tinnitus, sensorineural hearing loss, vestibular disorders;
• problems from the cardiovascular system;
• mood volatility, depression;
• fatigue, weakness;
• sleep disturbance;
• weather sensitivity.

Arterial hypertension, angina attacks are not always a direct consequence of anomalies of the vertebral vessels. Usually, the combination of cardiac pathology with hypoplasia leads to an aggravation of the course of the disease. At the same time, reduced blood flow in the vertebrobasilar basin provokes episodes of myocardial ischemia and an increase in blood pressure.

Hypoplasia of the right vertebral artery increases the risk of cerebral stroke due to impaired blood flow in the vertebrobasilar system and due to damage to the vascular wall in the event of atherosclerosis.

Treatment Methods

In the case of vascular hypoplasia, a complete cure of the disease is impossible. Even after reconstructive surgery, only temporary compensation of local blood flow can be achieved.

Conservative therapy

Conservative treatment includes taking medications, physiotherapy methods, physiotherapy exercises, acupuncture. To improve the blood supply to the brain, several groups of drugs are used:

1. Vasodilators (cavinton, actovegin, ceraxon).
2. Neuroprotectors and nootropics (piracetam, glycine, picamilon, mexidol) that improve metabolic processes in the brain tissue.

Of the physiotherapeutic methods can be used:

• diadynamic currents;
• magnetotherapy;
• electrophoresis with drugs that have a vasodilating, analgesic effect.

Surgery

Surgical intervention can be performed in an open way or using an endovascular method (through small holes, without large incisions).

To restore blood flow, use:

• Stenting, in which a stent is inserted into the narrowing of the vessel - a frame to expand the narrowed area. Such stents can be impregnated with drugs.
• Angioplasty, in which a balloon is inserted into the narrowing zone, which is pumped with air to expand the vessel. Angioplasty and stenting can complement each other.
• In severe situations, a more complex reconstructive operation is performed: removal of the deformed area and prosthetics using the patient's own vein.

Forecast

The prognosis for the pathology of hypoplasia of the right vertebral artery depends on the degree of underdevelopment, compensatory mechanisms of the body, and comorbidities. In the absence of symptoms of deterioration of cerebral blood flow or minimal manifestations of pathology, the prognosis can be considered conditionally favorable.

Hypoplasia is considered a predisposing factor in the development of stroke. According to statistics, 70% of transient cerebrovascular accidents and 30% of strokes are associated with impaired blood flow in the vertebrobasilar system. Therefore, the detection of an anomaly requires the adoption of active preventive measures, especially in the presence of other risk factors.

The presence of pronounced manifestations of vertebrobasilar insufficiency significantly worsens the prognosis. With insufficient effectiveness of conservative therapy, only surgical treatment can improve the situation. Good results are obtained when using the endovascular method, which can be carried out even in patients with a high "surgical risk".

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Narrowing of the vertebral artery: right, left

With early diagnosis of vertebral compression and proper treatment, irreversible changes in brain tissue are prevented. Through this vessel, blood enters the brain tissues. About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

1. Dyspeptic phenomena (vomiting, nausea);

2. Painful cider of the cervical-occipital part;

3. Peripheral soreness (symptom of removing the helmet);

4. Strengthening the clinic when sleeping on a pillow;

The task of X-ray in the presence of a drop attack (sudden fall) is to establish the likelihood of a violation of blood supply in the vertebrobasilar basin, to identify possible displacement of the vertebrae, instability, scoliosis. For these purposes, functional images are taken with maximum flexion and extension of the neck. X-rays help to assess the degree of flexion of the cervical spine, exclude or confirm the instability of the vertebrae.

With any of these disorders, there is a decrease in vision, eye fatigue, pathology of the visual analyzer. With late therapy, it is impossible to prevent the irreversible development of visual impairment by either conservative or surgical methods. X-ray of the cervical spine does not show the shadow of the vessel. To study the state of blood supply, contrast angiography, magnetic resonance imaging, dopplerography is required.

The procedures are performed under local anesthesia. The stent is placed through a puncture in the femoral region. The introduction of the endoprosthesis is necessary to maintain the physiological lumen of the vessel. A few years ago, stenting was performed under X-ray control. A scoping was performed to visualize the insertion of the balloon stent. On the x-ray television screen, the movement of the balloon from the femoral to the vertebral artery is clearly visible. The procedure led to radiation exposure of the patient, therefore, at the present stage, the control of the intervention is carried out under the cover of ultrasound.

1. Head pain syndrome is characterized by dull, burning pain with localization in the parieto-occipital region. The symptom is aggravated with severe physical activity. The probable location of pain is the superciliary, temporal, parietal zones;

2. Symptoms from the gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency. It is impossible to fight them with drugs. The mechanism of dyspeptic disorders is the squeezing of the vertebral artery with impaired blood supply to the intestine;

3. Violations of the central nervous system - memory loss, changes in visual acuity, eye pain;

4. Vestibular disorders - disorientation, tinnitus;

1. Elimination of neurogenic spasm;

2. Improvement of microcirculation of the vertebrobasilar basin;

1. Magnetic resonance imaging allows you to determine the anomalies in the structure of the bone bed, in which the vessels go;

2. Radiography of the cervical region - to detect instability of the vertebrae, displacement, hernia of the neck, other anatomical structures that interfere with blood flow in the vertebrobasilar basin;

3. Dopplerography helps to assess deviations of blood flow from normal values. The more reduced circulation, the greater the likelihood of severe complications in the brain;

4. Duplex scanning - is prescribed to detect lesions localized on the inner wall of the vessel;

To determine the level of circulatory disorders in the region of the base of the brain, an ultrasound scan with Dopplerography is performed. The procedure is used not only to detect circulatory disorders, but also to dynamically monitor the nature of microcirculation during treatment with vasodilators.

MRI angiography is considered a fairly promising method that shows the state of the transcranial and brachiocephalic arteries. The study allows you to carefully study the nature of the cerebral blood supply, identify blood clots, stenosis of the vertebral artery. Magnetic tomography reveals atherosclerotic plaques, determine the features of angiography.

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Vertebral artery stenosis: symptoms

Possible consequences of vertebral artery stenosis and treatment of narrowing

Congenital or acquired vertebral artery stenosis is a pathological disorder that leads to ischemic disease and cerebral stroke.

The complexity of therapy lies in the fact that in the early stages of the disease there are practically no symptoms. Drug treatment brings relief only in 30-40% of cases.

The positive effect of prescribing drugs is temporary. A complete cure is possible only after a surgical operation.

What is spinal stenosis

Literally, the term stenosis means blockage, blockage, or narrowing of blood vessels. As a result of violations, the course of blood flow becomes more difficult, the intensity of supplying the brain with nutrients and oxygen decreases.

Signs of stenosis of the canal of the left vertebral artery begin to appear after the internal cavity of the vessel narrows by more than 50%.

Since the vertebral artery provides about 35-40% of the total blood supply to the brain, chronic insufficiency occurs, indicating itself with characteristic symptoms:

• Headaches - migraine crises are accompanied by dizziness, loss of visual clarity. Pain is not relieved with conventional analgesics.
• Lower back pain is one of the first symptoms of spinal vascular stenosis. The intensity is aggravated during walking, physical activity. The pain does not go away when you stop and at rest. A decrease in pain syndrome is observed when the back is tilted forward.
• Numbness of limbs. With the development of pathology and the continuation of the narrowing of the distal section, restless legs syndrome (pins and needles), muscle weakness, tingling are observed. Usually, discomfort disappears with a change in body position, especially when bending forward.
• An increase in blood pressure occurs due to independent attempts by the body to ensure normal blood supply to the brain. With prolonged hypertension, symptoms characteristic of arterial hypertension are observed: decreased visual acuity, impaired coordination of movement, etc.

The appearance of clinical manifestations indicates that pathological changes have passed into a life-threatening form for the patient.

There are three main causes of vertebral artery stenosis:

1. Congenital factor - genetic predisposition leads to congenital disorders in the structure of blood vessels.

If the progression of the disease does not occur, with such stenosis they live a full life, with virtually no restrictions.

How dangerous is the disease

The prognosis of the disease is extremely unfavorable and mainly depends on the localization of pathological changes. Critical stenosis of the right vertebral artery leads to a stroke, a fatal outcome is possible. A progressive form of the disease is a criterion for disability.

Regardless of whether surgical treatment was performed, the patient in the later stages of stenosis is placed on a disability group. Disability can be assigned taking into account the consequences of stenosis (stroke, etc.).

) Methods of treatment of the disease and the consequences of stenosis largely depend on its localization.

• Oral stenosis - characterized by serious emotional disturbances: attacks of panic fear of death, frontal pressing pain and associated irritability, photophobia. Depending on the causes of pathological changes, surgical intervention, drug therapy in the preoperative period is recommended.
• Subcompensated stenosis - mainly occurs as a result of a traumatic factor. It is impossible to cure with the help of drug therapy; prompt surgical correction is necessary. Another common cause of development is cancer. In this case, the pathology often ends in death.
• Vertebrogenic stenosis - characteristic signs are pain in the lower back and sacral region. Stenosis is not accompanied by inflammatory processes. MRI shows signs of moderate atrophy of the frontal lobe of the cerebral cortex.
• Compensated stenosis - the development of pathology is slow, there are no signs of an acute form of the disease. As a result, there is no need for urgent surgical intervention.
• Stenosis of the intracranial section - accompanied by thrombosis of the artery. In an unfavorable combination of circumstances, the disease progresses rapidly and a stroke occurs.
• Stenosis of extravasal compression of the left vertebral artery - develops as a result of abnormal diseases of the spine. The cause of development can be osteochondrosis of the cervical region, hernia, oncological neoplasm and other pathologies. After eliminating the causes of the development of the disease, the blood supply, as a rule, is restored.
• Stenosis of extravasal compression of the right vertebral artery - for this diagnosis, the etiology and causes of development are identical to the narrowing observed in the left side of the spine.
• Dynamic stenosis - accompanied by complete or partial occlusion of the vessel. It is extremely dangerous for the life of the patient. Drug therapy relieves only the symptoms and is mainly used to prepare the patient for surgery.
• Functional stenosis - symptoms occur only at a certain position of the neck. The development of the disease occurs only against the background of osteochondrosis, spondylosis and other disorders of the structure of the spine.
• Multifocal stenosis - multiple vascular lesions. The surgery is ineffective. Drug therapy is prescribed, and if it is ineffective, angioplasty with complete replacement of the damaged parts of the arteries
• Hemodynamically significant stenosis is a condition in which vasoconstriction of more than 50% is observed. As a result, a condition occurs that affects normal blood flow and, accordingly, brain activity.
• Decompensated stenosis is one of the most severe conditions. The narrowing of the lumen of the vessels takes a chronic form and becomes irreversible. The only possible solution is the complete replacement of the damaged part of the artery or the creation of a duplicating channel.

Before prescribing methods of therapy, it is necessary to conduct a differential diagnosis to determine the exact cause of the development of disorders, the degree of development and the form of the disease. Classification of the degree of stenosis plays an important role in determining the appropriateness of the appointment of a surgical operation.

What methods are used to treat the disease

There are three main areas of therapy for stenosis of the vessels of the spinal column.

1. Drug therapy - vascular drugs are prescribed that promote the development of elasticity and strength, drugs to control blood pressure, which thin the blood and help reduce blood clots.

At the same time, physiotherapy exercises, manual therapy and hirudotherapy are used in complex therapy.

To prescribe the optimal type of therapy, the attending physician refers to several diagnostic procedures.

One of the most informative ways to obtain a complete picture of pathological changes is duplex scanning of the arteries. In addition, an MRI of the stenosis may be required.

Ultimately, the decision of how to treat depends on the patient. If the patient has constant dizziness, chronic lack of air, vasoconstriction over 70%, are absolute indications for a surgical operation.

What is the best diet for treatment

The therapeutic diet is aimed at overcoming the causes of the development of narrowing of the arteries. There is no specially designed diet.

Instead, eat as much fish (of any variety), fruits, and vegetables as possible. Caution should be taken when drinking alcohol, coffee and tea.

It has been observed that losing just a few kilograms reduces the risk of rapid development of stenosis due to atherosclerosis. Therapeutic gymnastics is one of the best ways to normalize the patient's weight.

Although recently there have been many developments aimed at overcoming stenosis, so far the only method of combating the disease with high efficiency remains a surgical operation.

Stenosis of the vertebral artery: left, right, what it is, symptoms

Stenosis of the vertebral artery is its narrowing, as a result of which blood circulation in the brain is disturbed, nutritional deficiencies occur, oxygen starvation of nerve cells (neurons) and ischemic stroke. The vertebral arteries (VA) are one of the main vessels that run along both sides of the spine (left and right arteries) and supply the brain with blood (up to 25% of the total volume of blood entering the head).

Essence of pathology

Chronic insufficiency occurs when there is a shortage of 35-40% of the blood and is characterized by the following symptoms:

• dizziness, migraines, which are not affected by analgesics;
• deterioration of vision - the phenomena of flies, dark spots or visual images before the eyes;
• deterioration of memory and intellectual abilities;
• impaired coordination of movements due to damage to the cerebellum;
• lumbar pain, aggravated by walking and exercise, subsides when bending forward;
• feeling of numbness of the extremities, tingling and "goosebumps" in the legs, weakness in the muscles;
• arterial hypertension;
• pain in the cervical region.

If the vertebral artery is narrowed by half, then the patient's condition worsens, sudden attacks of loss of consciousness and circulatory failures become more frequent, in which part of the brain cells die.

Reasons for the development of stenosis

According to the factors that provoked the development of stenosis, 3 main groups are classified:

1. Hereditary pathologies associated with blood vessels. In the absence of exacerbation, the disease does not manifest itself and the person remains active throughout life.
2. Stenosis acquired as a result of diseases affecting blood circulation (atherosclerosis, diabetes and metabolic disorders).
3. Narrowing of the walls of the arteries due to injury (bruise, fracture, hematoma).

Reasons for the development of stenosis:

• diseases that cause degeneration and dystrophy of the vertebral columns of the cervical region (osteochondrosis, spondylosis, ankylosing spondylitis), which led to the mixing of the vertebrae and impaired brain microcirculation;
• atherosclerosis of blood vessels due to the concentration of cholesterol plaques in the cavity of the vessels;
• tumors of the vertebral processes;
• bone growths (osteophytes) in the joints of the intervertebral space;
• hypertonicity and spasms of the cervical and scalene muscles.

Depending on the affected areas, the following types of VA stenosis are distinguished:

1. Oral stenosis is a form of damage to the vertebral arteries on the right or left, accompanied by mental disorders that manifest themselves in outbreaks of panic attacks, fear of death, compression pain in the frontal part, irritability and fear of light. The main treatment is surgical.
2. Subcompensated stenosis is provoked by injuries and resulting displacements in the cervical spine. Surgery is needed to correct post-traumatic complications. If the lesion is caused by an oncological tumor, then such a disease ends lethally.
3. Vertebrogenic stenosis - characterized by the manifestation of pain in the lumbar and sacral regions of the spine without any inflammation processes and moderate changes in the frontal lobe of the cerebral cortex. The vertebral vessel is examined using MRI. Surgical treatment by means of stenting through a puncture of the femoral artery and the installation of an endoprosthesis.
4. Compensated stenosis - characterized by a slow course of the disease, when the lumen of the walls of the vessels narrows gradually and makes it possible to treat the disease with medication, without surgery.
5. Stenosis of the intracranial region - causes thrombosis of the artery, progresses rapidly and provokes a stroke.
6. The narrowing of the left vertebral artery is the result of abnormal changes in the spine (cervical osteochondrosis, intervertebral hernia, cancerous tumors). The prognosis with the complete elimination of the sources of the development of the disease is favorable, the blood supply to the brain tissues is restored.
7. Stenosis of the right vertebral artery - symptoms and treatment are similar to stenosis in the left side of the spine.
8. Dynamic narrowing of the PA - is expressed in a complete or partial violation of the patency of the arteries and is considered the most dangerous type of stenosis. Treatment with drugs is only symptomatic, emergency surgical care is required.
9. Functional stenosis - manifests itself only at a certain position of the neck, progresses due to existing osteochondrosis, spondylosis and other lesions of the spine.
10. Multifocal stenoses are lesions of several or many vessels. Only drug therapy or angioplasty is used, which involves replacing the affected tissues of the arteries.
11. Hemodynamic vasoconstriction means that the obstruction has affected more than half of the vessel, in which the vital activity of the brain is disrupted.
12. Decompensated stenosis - the disease becomes chronic, the process becomes irreversible. The prognosis is relatively favorable with the complete replacement of the narrowed section of the arterial vessel or the creation of an alternative blood channel.
13. Stenosis of the spinal canal due to its narrowing. This type of stenosis occurs in the lumbar region and causes compression of the nerve roots of the lumbar plexus and neuralgia of the sciatic nerve. It can also be observed in the cervical spinal cord, squeezing the latter, which can lead to complete paralysis.

Diagnosis of insufficiency of cerebral blood supply

To study the blood circulation of the brain, the following instrumental methods are used:

• dopplerogram of the vessels of the cervical spine to identify the processes of narrowing of the arteries;
• angiography - the introduction of contrast agents into the vessels and their radiograph to exclude atherosclerotic and anatomical disorders of the vascular system;
• magnetic resonance angiography - scanning of contrast arteries;
• CT with the use of a contrast solution injected into the artery to determine the degree of stenosis;
• contrast panangiography - an x-ray using contrast agents, which allows you to identify the presence and location of a blood clot for a surgical operation.

Treatment of the disease

Narrowing of the vertebral artery is a disease that requires timely treatment, otherwise complications can lead to ischemic stroke. Treatment of stenosis is prescribed based on the causes of pathological processes and the type of stenosis.

Drug therapy provides for the impact on the signs of the disease, suppressing their manifestation: drugs that lower blood pressure are used (Indap, Lozap, Dibazol, etc.

); orthopedic collars that limit the mobility of the cervical vertebrae; anticoagulants; means for normalizing blood circulation (Cinnarizine, Mildronate, Encephabol, Vasobral, Instenon, etc.); NSAIDs.

However, drug treatment is effective only in 30-40% of cases, and there is a danger of regression of the disease.

Surgical intervention involves various types of operations, depending on the course and localization of the process of narrowing of the walls of the vessels. Among them:

1. Endarterectomy - resection of damaged areas of the artery and the introduction of an implant (stent).
2. Reconstructive surgeries - arteriolysis, resection and redressing of damaged parts of the VA.
3. Stabilization of the movement of the mobile part of the spine.
4. Removal of osteophytes - bone growths in the intervertebral joints.
5. Stenting is the introduction of a metal frame sheathed with plastic into the canal of the artery, which protects the walls of the vessel from narrowing.
6. Fixation of the cervical region during the removal of some articular elements by installing special titanium systems.

Prognosis of VA stenosis

The prognosis of the disease in the vast majority of cases is quite unfavorable, the outcome is affected by the location of degenerative changes in the VA.

Critical stenosis of the right VA, as a rule, ends in a stroke with a possible fatal outcome.

Patients who have suffered this disease are assigned a disability.

Symptoms and treatment of vertebral artery stenosis

Vertebral artery stenosis is a disease that can be either congenital or acquired.

The most frequent and formidable complications in this case are coronary heart disease and stroke.

And the complexity of the treatment of such a pathology is that at the initial stages there are almost no symptoms at all.

The term itself means nothing more than a blockage, blockage or vasoconstriction.

As a result, there is a violation of blood flow, as a result of which the brain receives an insufficient volume of blood for it, which means oxygen and nutrients.

The first signs begin to appear when the narrowing of the artery reaches 50%, and even with a shortage of 40% of the total blood supply, chronic insufficiency occurs, which manifests itself with the following symptoms:

1. Headaches, accompanied by dizziness, loss of visual acuity and clarity. Moreover, the pain syndrome can not be removed with analgesics or other drugs.
2. Pain in the lower back. This is one of the main symptoms of spinal vasoconstriction. The intensity becomes maximum when walking, during the period of physical activity, and the pain does not disappear even at rest. A posture in which the back is tilted forward helps to reduce it.
3. Numbness of the extremities, which manifests itself in restless legs syndrome, muscle weakness, tingling. Most often, such manifestations disappear after a change in body position.
4. High blood pressure is an attempt by the body to compensate for the lack of blood flow to the brain.

All these manifestations mean that pathological changes in the vessels have reached a life-threatening stage for the patient.

The reasons

Stenosis of the vertebral arteries does not occur without a cause. Three reasons are known for its development today.

In the first case, this is a congenital factor, that is, a genetic predisposition that leads to any congenital disorders in the structure of the vessel.

If the progression of the disease does not occur, then people with such pathologies can live for many years without limiting themselves in anything.

The second reason is the acquired factor. This is the very reason that requires mandatory treatment. Provoke blockage can atherosclerosis, diabetes, metabolic disorders.

And finally, the third factor is traumatic. The narrowing of the artery can occur due to a fracture, bruise, if a hematoma occurs. In this case, surgical treatment is mandatory.

How dangerous

In the presence of symptoms, the prognosis of vertebral artery stenosis is extremely unfavorable. A progressive form is always a reason for disability. But the treatment will completely depend on where exactly the pathology is localized.

The ostium form is always emotional disturbances, which can be expressed in panic attacks, photophobia. The main treatment is surgical, before surgery, drug therapy is required.

Subcompensated form occurs as a complication of traumatic injury. Medical treatment is not possible, only surgery is needed. Another fairly common cause is cancer. In this case, most often the patient dies literally within a year.

Vertebrogenic stenosis is characterized by pain in the lower back and sacrum. At the same time, no inflammatory processes can be identified.

The compensated form proceeds slowly, there are no signs of an acute onset, there is no need for urgent surgical treatment.

Intracranial stenosis occurs with arterial thrombosis and is usually fatal.

Stenosis of extravasal compression on the left is a consequence of diseases of the spine. The cause may be osteochondrosis, hernia, oncology. After the causes are eliminated, the blood supply most often resumes in a normal volume.

Stenosis of extravasal compression on the right has the same causes as the previous version.

The dynamic type is accompanied by complete or partial vascular occlusion. This is the most life-threatening condition. Medicines can only help to overcome the symptoms themselves, but it is possible to cure the pathology only with the help of surgery.

A functional symptom begins to manifest itself only in one or another position of the neck. The basis of the disease is spondylosis, osteochondrosis and other disorders.

Multifocal stenoses have numerous causes. The only way out is angioplasty with the replacement of a section of the damaged artery.

Hemodynamically significant stenosis is observed when the vessel narrows by more than 50%.

The decompensated form is one of the most severe, when vasoconstriction is completely irreversible. The only way out is to completely replace the affected area or create a bypass channel for blood flow.

Treatment of vertebral artery stenosis begins after diagnosis and determination of the type of disease. The most commonly used surgery, drug treatment is used extremely rarely.

Narrowing of the vertebral artery: right, left | Second opinion

Stenosis (narrowing) of the vertebral artery (left or right) leads to severe brain symptoms: severe pain in the left and right half of the head, loss of consciousness, convulsions. With the right stenosis, the pain syndrome is localized on the right, with the left - on the opposite side.

With early diagnosis of vertebral compression and proper treatment, irreversible changes in brain tissue are prevented.

Through this vessel, blood enters the brain tissues.

About 20% of the structures are fed by blood supply from the vertebral arteries on the right and left, passing through the openings of the transverse processes of the vertebrae of the neck.

MRI of the cervical spine in a patient with vertebrobasilar insufficiency

Radiography with narrowing of the lumen of the vertebral artery: right or left

Traditional radiography with narrowing of the lumen of the vertebral arteries (right or left) does not show pathological manifestations. Neuropathologists send patients with certain clinical symptoms to the picture:

1. Dyspeptic phenomena (vomiting, nausea); 2. Painful cider of the cervical-occipital part; 3. Peripheral soreness (symptom of removing the helmet); 4. Strengthening the clinic when sleeping on a pillow;

5. Shooting, throbbing pains when externally applied to the head (touch, breath of wind).

In patients with vertebral artery stenosis, neuropathologists often observe vestibular syndrome, in which staggering, unsteadiness, severe dizziness attacks are observed.

Even with an uncomplicated course, a short-term loss of consciousness is possible with a sharp turn of the head, vibration, pressure on the neck. With such clinical symptoms, a person should not drive a car.

Noise, nausea, hearing loss is a manifestation of a number of secondary pathologies on the part of the inner ear, the brain.

With traditional radiography of the cervical spine, narrowing of the intervertebral discs is visualized during the degenerative-dystrophic process, prolapse, hernia.

The task of X-ray in the presence of a drop attack (sudden fall) is to establish the likelihood of a violation of blood supply in the vertebrobasilar basin, to identify possible displacement of the vertebrae, instability, scoliosis.

For these purposes, functional images are taken with maximum flexion and extension of the neck.

X-rays help to assess the degree of flexion of the cervical spine, exclude or confirm the instability of the vertebrae.

MR angiography of the vertebral arteries in stenosis The radiologist, when prescribing radiography, reveals the growth of marginal osteophytes in the region of the semilunar joints. Changes are clearly visualized on a direct picture. Osteophytes are localized along the upper edge of the contours of the anterior part of the vertebral bodies.

On the lateral radiographs of the cervical spine, the state of the cervical vertebrae, intervertebral spaces, hyperlordosis (excessive bulge of the natural curvature) is studied.

With any of these disorders, there is a decrease in vision, eye fatigue, pathology of the visual analyzer.

With late therapy, it is impossible to prevent the irreversible development of visual impairment by either conservative or surgical methods. X-ray of the cervical spine does not show the shadow of the vessel.

To study the state of blood supply, contrast angiography, magnetic resonance imaging, dopplerography is required.

Methods of radiation diagnosis of stenosis of the right or left vertebral artery will be considered below.

Why does narrowing of the vertebral artery develop?

Violation of the blood supply to the brain depends on the degree of compression of the vertebral artery. The narrowing is caused by atherosclerosis, nerve spasm, external compression of the vertebrae, tumor, thromboembolism.

The cause of impaired blood supply to the vertebrobasilar basin may be the tortuosity of one or both vertebral arteries. For the treatment of pathology, stenting, balloon angioplasty is used.

The procedures are performed under local anesthesia. The stent is placed through a puncture in the femoral region. The introduction of the endoprosthesis is necessary to maintain the physiological lumen of the vessel.

A few years ago, stenting was performed under X-ray control. A scoping was performed to visualize the insertion of the balloon stent.

On the x-ray television screen, the movement of the balloon from the femoral to the vertebral artery is clearly visible.

The procedure led to radiation exposure of the patient, therefore, at the present stage, the control of the intervention is carried out under the cover of ultrasound.

Narrowing of the left vertebral artery: symptoms

You can suspect a narrowing of the left vertebral artery if you have the following symptoms:

1. Head pain syndrome is characterized by dull, burning pain with localization in the parieto-occipital region. The symptom is aggravated with severe physical activity.

The probable location of pain is the superciliary, temporal, parietal zones; 2. Symptoms from the gastrointestinal tract. Nausea and vomiting occur in many patients with vertebrobasilar insufficiency.

It is impossible to fight them with drugs. The mechanism of dyspeptic disorders is the squeezing of the vertebral artery with impaired blood supply to the intestine; 3.

Disorders of the central nervous system - memory loss, changes in visual acuity, eye pain; 4. Vestibular disorders - disorientation, tinnitus;

5. Change in the frequency of contractions of the cardiovascular system, pressure instability, angina attacks.

In addition to surgical and conservative treatment, patients with vertebrobasilar insufficiency need to undergo an additional set of treatment procedures - physiotherapy, massage, kinesiotherapy (treatment with physical movements).

The narrowing of both vertebral arteries is a dangerous pathology in which serious complications develop.

Radiography of the cervical region in the lateral projection with a decrease in the height of the vertebral bodies at the lower level

Difficulties are caused by timely diagnosis of nosology. To detect the disease, not only x-rays are used, but also other radiation diagnostic methods.

Principles of treatment of vertebral artery syndrome

With narrowing of both vertebral arteries, treatment is aimed at eliminating the main pathogenetic links of the process:

1. Elimination of neurogenic spasm; 2. Improvement of microcirculation of the vertebrobasilar basin;

3. Vertebrogenic effect on vascular wall tone.

Comprehensive treatment necessarily includes agents that reduce blood viscosity, dilate blood vessels - dipyridamole, pentoxifylline, vinpocetine.

Radiography with narrowing of the right or left vertebral artery is not used to diagnose the disease, but to identify a possible cause of compression of the vertebral vessel in the neck.

Methods for detecting compression of vertebral vessels (right and left)

Methods for diagnosing stenosis of vertebral vessels on both sides:

1. Magnetic resonance imaging allows you to determine the anomalies in the structure of the bone bed, in which the vessels go; 2.

X-ray of the cervical region - to detect instability of the vertebrae, displacement, hernia of the neck, and other anatomical structures that interfere with blood flow in the vertebrobasilar basin; 3. Dopplerography helps to assess deviations of blood flow from normal values.

The more reduced circulation, the greater the likelihood of severe complications in the brain; 4. Duplex scanning - is prescribed to detect lesions localized on the inner wall of the vessel;

5. Angiography of the cervical vessels - a study after the introduction of contrast into the vessel. For visualization, CT or MRI can be used, since the methods allow you to create a three-dimensional modeling of the state of the neck.

To determine the level of circulatory disorders in the region of the base of the brain, an ultrasound scan with Dopplerography is performed.

The procedure is used not only to detect circulatory disorders, but also to dynamically monitor the nature of microcirculation during treatment with vasodilators.

Neuroimaging by magnetic resonance imaging may be used to determine changes in the brain leading to similar symptoms.

MRI angiography is considered a fairly promising method that shows the state of the transcranial and brachiocephalic arteries.

The study allows you to carefully study the nature of the cerebral blood supply, identify blood clots, stenosis of the vertebral artery.

Magnetic tomography reveals atherosclerotic plaques, determine the features of angiography.

X-ray of the cervical spine is used in conjunction with MRI for additional diagnostics. To obtain maximum information, it is recommended to perform functional tests at maximum extension and flexion.

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Narrowing of the vertebral arteries

As a result of narrowing of the vertebral arteries, there may be an insufficiency of the arterial blood supply to the brain.

The atherosclerotic mechanism of cerebral circulation disorders, according to De Bakey, is observed in approximately 40% of all cases of cerebral circulation disorders.

Occlusions of arterial vessels can be partial and complete; the length of the blockage can be short or long, along the entire length of the artery.

Symptoms of narrowing of the vertebral artery

Occlusion of the vertebral artery is manifested by signs of insufficiency of the arterial vessels of the base of the brain: visual disturbances (of cortical origin) and symptoms of cerebellar damage (poor balance, diplopia, bilateral blindness or hemianopsia), as well as bilateral disorders of sensitivity and movement, expressed differently. These disturbances may be transient or permanent.

The diagnosis of sclerotic narrowing of the vertebral arteries can be suspected during a routine clinical examination of the patient based on his anamnesis (transient neurological symptoms - paresis and paralysis, "flickering symptoms"), systolic murmur on the arterial vessels, a symptom of loss of consciousness with unilateral pressing of the carotid artery.

With electroencephalography, pathological changes are found only with severe neurological symptoms, which reduces the value of this research method.

In some cases, electrical activity increases when the carotid artery of the other side is pressed or the head is raised sharply.

Topical diagnosis using electroencephalography is not possible.

The most accurate data on the localization and spread of the lesion can be obtained with arteriography of the vertebral arteries.

It should be performed as soon as possible, especially after an attack of arterial insufficiency of the brain, and if the symptoms of cerebral ischemia do not go away, then this study is carried out as an emergency intervention.

Arteriography of the vertebral artery is done by percutaneous puncture of the subclavian artery in the supraclavicular region. Enter 20 ml of 50% triiotrast.

It is necessary to examine the arterial vessel on the other side as well, since bilateral lesions occur at least in 25% of cases. An x-ray is taken at the end of the injection of the contrast solution.

The study is then carried out on the opposite side.

Partial narrowing of the vertebral artery, visible on the arteriogram in the form of “filling defects”, “corrodedness” of the contours of the artery wall, is an indication for surgery. If there is a complete blockage, the vessel is not filled with contrast solution and is completely invisible on the arteriogram.

Treatment of narrowing of the vertebral artery

The success of surgical treatment depends primarily on how early the operation is performed after the onset of the disease.

In some cases, the operation brings success in the late period. The purpose of the operation is to restore the blood supply to the brain.

Two methods of operation are used: endarterectomy or bypass shunting with a plastic prosthesis.

Intimendarterectomy - removal of the altered intima along with a sclerotic plaque and a thrombus superimposed on it.

Endarterectomy of the vertebral artery due to its small caliber is performed from the lumen of the subclavian artery.

For this, the latter is dissected longitudinally above the place of origin of the vertebral artery.

In case of simultaneous occlusion of the same-named artery of the opposite side, special measures are required to protect the brain from ischemia for the duration of the operation.

For this purpose, a temporary external or internal (through the lumen of the artery) shunt is applied with a thin polyethylene tube. In addition, the decrease in blood flow is compensated by an increase in blood pressure by administering norepinephrine.

Blood clotting in the temporary bypass shunt is prevented by the administration of heparin.

In most cases, however, no special ischemia brain is required for the period of surgical intervention (5-30 minutes), since the collateral blood supply is quite sufficient.

The operation brings either complete relief from the symptoms of insufficient blood supply to the brain, or a significant improvement in the condition. The results of treatment, tracked for 5 years, remained persistent.

The best effect is observed after an operation performed at the stage of sclerotic narrowing of the vessel, and not its occlusion. With complete blockage of the vessel, the operation is successful if it is performed shortly after the onset of the disease.

Improved diagnosis and earlier appeal for surgical assistance will further improve the results of surgical treatment of sclerotic lesions of the main arterial vessels supplying the brain.

Healthy:

symptoms, treatment and mcb 10

The method of therapy and the fight against its consequences directly depend on the form of the disease and its localization. Vertebral artery stenosis can be:

Causes of the disease

There are three main causes of vertebral artery stenosis:

• genetic predisposition. It can lead to congenital disorders of the very structure of the vessels. If the disease does not progress, then they live a full normal life with it, without obvious restrictions.
• acquired factor. Clogging of blood vessels is provoked by the following pathologies: atherosclerosis, metabolic disorders and diabetes. For this reason, mandatory treatment of the vertebral artery is necessary.
• trauma factor. Narrowing of the vertebral artery can occur due to a bruise, fracture, or hematoma formation at the site of injury. In this case, it is necessary to prescribe surgical treatment in order to eliminate the causes of blockage of the artery.

The causes of the disease are associated with the intrauterine development of the child:

Symptoms

The syndrome is expressed in a peculiar way, so patients note the following symptoms:

It can be burning or throbbing, extending to the temple, crown or superciliary region.

Feature: the pain is localized either in the right or left side of the head. The pain is constantly pestering the patient, but is especially intensified during walking or during sleep, if the position of the head or body predisposes to this.

Much less often, the pain is paroxysmal in nature. Often patients say that the pain has stopped, but they could not find a logical explanation for this. The reason for this is the position of the head. But there are no general rules about what position the head should be in order for the pain to disappear;

• visual disturbances (decrease in sharpness, a feeling of sand in the eyes, a veil in the eyes) or pain in the eyeballs;
• auditory or vestibular disturbances, for example, dizziness, loss of balance, noise in one ear, hearing loss;
• cardiac manifestations, if a person has cardiovascular diseases, for example, hypertension, coronary heart disease.

If the patient suffers from coronary heart disease, angina attacks may occur in the form of acute pain in the heart area.

The development of the syndrome, in which the vertebral artery suffers, takes place in two stages - dystonic and organic. Symptoms and treatment vary for each stage, and it is important to determine the extent of arterial damage by looking at information about the signs of the course of the disease.

In the first case, a person begins to feel symptoms such as:

• constant pain in the temporal and occipital region of the head, which increases with movement or being in one position for a long time;
• transient dizziness of varying intensity;
• visual disturbances, expressed in the appearance of "flies", "snowflakes". There is also a unilateral decrease in peripheral visual acuity.

Signs of the organic course of the disease have the following symptoms:

Diagnostics

Diagnosis of vertebral artery syndrome involves several different studies.

First of all, the diagnosis is based on the data that can be obtained from the clinical picture of the disease. We are talking about the patient's complaints, as well as the information that was obtained by the doctor during the neurological examination.

Quite often, the diagnosis allows you to detect the tension of the occipital muscles, the presence of difficulties when turning the head, pain when pressing on the processes of the first and second cervical vertebrae.

In addition, diagnostics means mandatory:

Circulatory disorders in the vertebral artery are diagnosed by Doppler ultrasound (USDG). The method of studying the arteries of the vertebrobasilar basin and the carotid is called USDG of the branches of the aortic arch. In this case, the carotid arteries are fully examined, and the vertebral arteries are partially examined.

In this case, most often the examination begins with a blood test, which shows possible problems with the arteries.

Also, the standard procedure is the measurement of blood pressure, this indicator can not only detect arterial hypertension, but also determine the load on the vessels, and therefore clarify risk factors for various diseases.

After that, additional diagnostics can be assigned.

The disease can be detected during the first examination by a neurologist. The doctor listens to the patient's complaints about the general condition, takes into account possible violations in the cervical region, and writes out a referral for ultrasound diagnostics.

If during the examination a narrowing of the lumen in the diameter of the vertebral artery up to 2 mm was detected at a rate of 3.6 - 3.8 mm, this is considered a diagnostic symptom proving the presence of the disease. If necessary, angiography is performed - X-ray diagnostics of blood vessels by introducing a contrast agent, clearly demonstrating their current state.

If a disease is suspected, the doctor should write out a referral for an ultrasound of the vessels. This diagnostic allows you to determine the diameter of the artery.

An anomaly is a narrowing of the inner diameter, the norm varies in the range of 3.6 - 3.8 mm.

According to the indications, tomography and angiography of the arteries are performed using a contrast agent.

These studies help to get a complete picture of vascular anomalies.

Often, hypoplasia is aggravated under the influence of disorders of the vertebrae located in the cervical region. It can also be detected during diagnostics.

The following methods allow you to put a competent one:

Treatment

Stenosis can be treated using three effective methods:

Modern medicine offers many methods of treating arteries, both conservative and surgical. However, until now, these diseases remain one of the most severe and difficult to treat.

This is largely due to the fact that the processes taking place in the left and right arteries of the limbs, the main vessels, the vessels of the brain and heart, are influenced by many factors, for example, the composition of the blood, the work of the heart muscle, the state of the veins, and age-related changes in tissues.

Therefore, treatment should be carried out comprehensively, taking into account all possible causes.

Depending on the stage of development and the presence of factors influencing the clinical picture, the treatment of vertebral artery syndrome may be conservative or surgical intervention may be required. With a dystonic course of the syndrome, a drug method gives a good result, in which the patient is given drugs that stimulate blood flow and improve the chemical composition of the blood.

At the same time, physiotherapy can be prescribed, which will help increase the gap between the walls of the arteries and eliminate the early stages of osteochondrosis.

In some cases, in the treatment of cervical osteochondrosis, special gymnastics deserves good reviews, which not only reduces discomfort, but also improves cerebral blood supply.

Treatment is carried out in two ways:

1. Conservative. It involves the introduction of drugs that improve the properties of blood, blood supply to the brain and metabolic processes in it. Such methods do not completely eliminate the disease, but only protect the brain from ischemic abnormalities. For this, various drugs are used, in particular blood-thinning agents.
2. Surgical. It is used in situations where it is impossible to compensate for cerebral circulation in other ways. Experienced surgeons perform endovascular surgery, the meaning of which is the introduction of a stent into the lumen of a narrowed vessel. This is a special expander that increases the diameter of the artery, normalizing blood flow.

To eliminate vascular manifestations, specialists prescribe drugs to patients that improve brain nutrition.

Medicines activate metabolic processes in the nervous system, protect its cells from the repeated action of the aggressor.

Conservative treatment relieves only the symptoms - the consequences of vascular damage.

Prevention

Since atherosclerosis and coronary heart disease are chronic progressive diseases, it is very important to pay sufficient attention to prevention.

After all, this is how you can prevent the disease itself, as well as slow down its progression.

the purpose of such measures is to optimize the composition of arterial blood so that it does not contain factors that contribute to the formation of plaques.

Food

Try not to lift or hold heavy objects with outstretched arms. You need to correctly learn how to carry weights so as not to hurt your back. With an even posture, you need to squat down, take the load and straighten your legs with it.

In this case, place your hands as close to the body as possible. Distribute the load evenly so you don't have to carry it in one hand if you can carry two bags in both hands.

Use bags, carts, and wheeled cases to transport heavy items.

Hypoplasia of the vertebral artery: signs, treatment, consequences

Hypoplasia of the vertebral artery is most often a congenital defect, and can be either right-sided or left-sided. In the future, the disease leads to a violation of hemodynamics (circulation), which especially affects the posterior parts of the brain. Most often, this causes numerous dysfunctions in the work of the heart and circulatory system as a whole, the vestibular apparatus and other organs.

General information about hypoplasia

Full blood circulation in all parts of the brain is possible due to; it is formed from the right and left branches of the spinal arteries.

Under normal conditions, both the right and left vertebral arteries are equally developed. In the region of the subclavian artery towards the cranial cavity, they are divided into small vessels.

The term "hypoplasia" in medicine describes the underdevelopment of tissues or an organ; it can be both a congenital pathology and an acquired one.

Bilateral hypoplasia is much less common than right-sided or left-sided, although the latter case is already considered quite rare. But since the adaptive capabilities of the body are not unlimited, their depletion very quickly leads to the stage of decompensation and the need for surgical intervention.

Causes and consequences of the disease

How does hypoplasia develop?

The factors that influence the occurrence of hypoplasia affect the human body even in the womb, however, the same can be said about most diseases and birth defects.

It is believed that the following processes and phenomena can cause hypoplasia:

• Bruises and various injuries of the mother during pregnancy;
• The abuse of certain drugs, alcohol, nicotine, and narcotic substances when carrying a child, toxic chemical compounds can also have a similar effect;
• Infectious diseases of the expectant mother;
• Genetic predisposition to diseases of the circulatory system;

Hypoplasia of the vertebral arteries does not always develop due to the above situations, these cases only significantly increase the risk of pathologies in the development and functioning of the circulatory system. But sometimes, however, children with congenital hypoplasia are born in the absence of any of the listed reasons. So modern medical luminaries do not yet have a consensus on this matter, although there are many conflicting theories.

What threatens the occurrence of the disease in the future?

In some cases, the defect does not make itself felt until a certain period or even throughout life, since hemodynamic disorders are attributed to other diseases or simply poor health, if the symptoms are not particularly pronounced.

The narrowing of the opening of the artery at the site of its confluence with the bone canal during hypoplasia significantly impedes the flow of blood to the brain tissues. The consequences of hypoplasia, therefore, can be unpredictable, and in this case it is far from immediately possible to identify the real cause of multiple dysfunctions. However, some of them do not pose a serious threat to health, but definitely worsen the quality of life. These include increased fatigue, periodic severe headaches, a decrease in visual acuity and hearing.

Symptoms and diagnosis of hypoplasia

Problem symptoms

The main characteristic of the disease is the variety of symptoms, which can vary significantly in each individual patient. This applies both to the intensity of pain sensations and to manifestations of underdevelopment of the vertebral arteries in general. In some cases, the patient learns about a possible diagnosis only when undergoing a routine medical examination, since the clinical picture is very blurred, and the symptoms of hypoplasia are very similar to the external manifestations of other diseases.

It is possible to talk about the presence of hypoplasia of the right or left arteries if the following signs are present:

1. Frequent causeless dizziness;
2. Headaches of varying intensity;
3. Distorted perception of the position of the body in space, which occurs suddenly;
4. Dysfunctions of the nervous system;
5. Violation or complete disappearance of sensitivity in certain areas (including limbs);
6. Frequent high blood pressure.

Nonspecific signs of hypoplasia are the result of circulatory disorders in the body, but it is quite difficult even for an experienced specialist to identify their true cause. These include dizziness accompanied by loss of consciousness, sudden disorientation in space due to incoordination, which can lead to a fall, and staggering when walking or changing body position.

Loss of coordination of movements is a rare, but rather unpleasant manifestation of hypoplasia. This usually looks like an unreasonable fall or collision with people or objects, and the person himself may experience sensations similar to those that appear after a long ride on a carousel.

Usually, the intensity and frequency of all signs of hypoplasia of the vertebral arteries increases with the aging of the body, since age-related phenomena include a decrease in the elasticity of small and large vessels and their clogging. Thus, the lumen in the arteries affected by hypoplasia is additionally reduced, and hemodynamics worsens.

Identification of the disease

If there are suspicions, it will be useful to make an appointment with a neurologist. Examination of the patient and existing complaints about well-being are the reason for a more thorough check than the initial examination. If during the examination the specialist detects anomalies in the cervical region, then, most likely, it is worth doing an ultrasound examination of the arteries of the spine.

The result of ultrasound is a confirmation or refutation of a possible diagnosis. The conditional norm is the diameter of the lumen from 3.6 to 3.8 mm; vasoconstriction up to 2 mm is considered the main diagnostic sign. As an additional examination, the doctor may also recommend a pass, which, using x-rays and certain contrast agents, allows you to accurately identify the condition of the blood vessels.

"Right" and "left" hypoplasia

Hypoplasia of the right vertebral artery

Most experts do not share the symptoms of right and left hypoplasia as specific when it comes to external manifestations of the disease.

A significant difference in symptoms is observed only in case of violation of some brain functions, since the branches of the subclavian artery feed its various departments. Thus, in different areas leads to different consequences. It is worth noting that the symptoms of hypoplasia of the right vertebral artery are almost always common.

In addition to the previously listed manifestations, this pathology of the development of the circulatory system can cause emotional disorders. Patients often experience unreasonable mood swings with a high polarity of mood swings. Weakness and lethargy often occur even without overload and stress as such, and a depressed state can last for several days in a row. Complaints of increased fatigue and drowsiness occur in almost every patient, as well as a severe headache. occurs both with hypoplasia of the right and left vertebral arteries.

Hypersensitivity or a complete loss of sensitivity in some parts of the body often indicates that the part of the brain responsible for a certain area suffers from poor blood flow. Sometimes this makes it possible to make the correct diagnosis or confirm the current one.

The main trouble in the pathology of the right vertebral artery are concomitant diseases, for which hypoplasia acts as a kind of catalyst for degenerative processes. One of these diseases is, which leads to additional circulatory disorders, since it significantly constricts blood vessels.

With hypoplasia of the right artery, a strong meteosensitivity may develop in the future, and sometimes there are problems with sleep.

The difference in the consequences of hypoplasia of the right and left vertebral arteries is explained by the fact that they feed different parts of the brain.

Hypoplasia of the left vertebral artery

Unlike the right one, hypoplasia of the left vertebral artery may not manifest itself immediately, but closer to adulthood, since the symptoms are associated with circulatory disorders.

Hemodynamic dysfunction manifests itself not only in the form of poor vascular patency and organ ischemia as a consequence, but also as stagnation of blood in others. This happens only after a fairly long period of time, since adaptation mechanisms can very effectively avoid problems in the work of the organism that develops due to a deterioration in blood flow for the time being. The clinical significance of symptoms increases with age-related changes in organs and tissues, and at the primary stages, special attention should be paid to some external manifestations.

Pain in the cervical spine is considered one of the most indicative signs of left artery hypoplasia, although in the absence of other symptoms it is impossible to make a correct diagnosis.

The appearance of connections between the branches of the main main vessels (vascular anastomoses) is a typical manifestation of the action of compensatory mechanisms in the underdevelopment of both vertebral arteries. The achieved effect is lost in case of deterioration of vascular patency due to concomitant diseases.

In the case of hypoplasia of the left artery, hypertension (increase in pressure) is a secondary disease, and, in fact, a mechanism for adapting the body to the existing state of affairs. Under high pressure, blood passes into the brain much more easily even through a hole of small diameter, since the lumen of the artery in the case of hypoplasia is much narrower.

Method of treatment of hypoplasia

Paradoxically, in certain cases, a person does not need treatment for vertebral artery hypoplasia, since the body's adaptive capabilities allow it to cope with hemodynamic disorders for a long time and prevent the appearance of clinical symptoms in principle, and the blood supply to the brain does not worsen.

But if the signs of the disease have already shown themselves, then you should not delay a visit to the doctor, since vivid symptoms almost always indicate quite serious health problems. Most often this happens due to, with constant high physical and emotional stress, as well as in case of failures in the work of compensatory mechanisms.

Atherosclerosis, as well as stenoses of vessels of a different nature, is one of the main causes of hypoplasia. Therefore, in order to get rid of health problems, treatment should be comprehensive and exclude phenomena that painfully constrict blood vessels.

In this case, hypoplasia should be treated as soon as possible in order to prevent a significant deterioration in well-being and, if possible, avoid surgery, although most often surgery (for example, and/or ) is the only alternative, as the disease becomes severe.

With a relatively early diagnosis, specialists still try to avoid surgical intervention in the patient's body with the help of drug therapy. Drugs and pressure lowering drugs are the mainstay of treatment, and are recommended as an adjuvant.

In addition to the above methods, modern medicine does not have other means, although some "alternative medicine centers" offer other procedures as therapy - acupuncture, massage, various gymnastic complexes. You should not unconditionally rely on the promises of people who most often do not even have a special education. If desired, and only after consultation with your doctor, you can combine both methods.

Video: stenosis of the mouth of the left vertebral artery. Angioplasty with stenting

Stenosis of the vertebral artery is a condition in which there is a compression of the main vessel and a violation of blood flow in it.

Against the background of the development of the disease, there is a deterioration in cerebral blood supply and the occurrence of various disorders. This is due to the fact that the vertebral arteries, together with the carotid arteries, serve as the main channels supplying blood to the organs of the neck and head. As a result of vasoconstriction, the nutrition of individual parts of the brain decreases and reversible violations of its functions take place. Poor supply of oxygen and substances leads to hypoxia of nerve cells, a complication of which is ischemic stroke. From this we can conclude that pathology poses a threat to human health and life, therefore, it needs timely and adequate treatment. If therapy is carried out at the stage when the vessel narrows only by half, then the prognosis will be favorable.

Stenosis of the vertebral artery, which is scientifically called vertebrobasilar syndrome- this is a congenital or acquired disease, a variety of factors can provoke it. Consider the main causes of the development of pathology, its symptoms and ways to correct the condition.

Etiology

The narrowing of the lumen of the main artery, as a rule, is a consequence of degenerative processes in the joints or vertebral discs surrounding the vessel.

The most susceptible to pathological changes are the lumbar and cervical regions. If the stenosis is of a congenital nature, then in its etiology there are deviations in the structure of the spine. Acquired disease progresses against the background of unfavorable the influence of various factors.

According to the nature of origin, they distinguish functional and organic stenosis. The first is the result of degenerative-dystrophic changes, such as Bechterew's disease, spondylosis, osteochondrosis. Such ailments lead to deformation and displacement of the vertebrae and the cessation of blood microcirculation.

In cases where there is instability of the elements of the cervical region, there is insufficiency of both vertebral vessels.

The cause of the progression of organic stenosis is atherosclerosis - a vascular disease characterized by the deposition of cholesterol plaques on the walls of the vertebral arteries. The formed fat and fibrous particles gradually increase in size and block the blood flow. Also provoking factors of this type of stenosis are tumors in the transverse processes of the vertebrae, osteophytes of small vertebral joints, and hypertonicity of the surrounding muscles.

Symptoms

How does vertebral artery stenosis manifest itself? The main signs of pathology are the following violations:

• visual disorders- ripples and flies before the eyes, photopsy, blurring, dark spots in the fields of vision;
• ataxia- inability to maintain the balance of the body, associated with a violation of the functionality of the cerebellum, poorly nourished by blood;
• vestibular disorders- frequent dizziness, inadequate reaction to bright light, involuntary oscillatory eye movements.

Diagnostics

To determine the presence of stenosis of the vertebral artery, the doctor relies on
the patient's medical history (existing symptoms of impaired vertebrobasilar insufficiency) and the results of the study. In the diagnosis of pathology, the following methods are used:

1. Doppler ultrasound of the neck vessels.
2. Angiography.
3. CT scan.
4. Magnetic resonance angiography.
5. Radiography.

Conducting a comprehensive study allows not only to determine the narrowing and its localization, but also to find out the causes of the pathological condition.

Treatment tactics

The choice of method of therapy depends on the type of stenosis and the degree of narrowing of the vertebral artery.

With a functional disease, conservative treatment is used, in particular drugs that reduce blood pressure. Also, when the vessels in the cervical spine are compressed, orthopedic correctors are used to limit the mobility of the vertebrae and prevent their mechanical effect on the vessels.

With an exacerbation of the pathology, drugs are prescribed that regulate the process of blood coagulation or surgical angiocorrection. Pharmacological agents of the neurotrophic group and antioxidants are effective in the treatment of stenosis. If necessary, blood circulation in the artery is normalized using surgical techniques.